| NPI | 1194719989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: KY 89) |
| Additional Taxonomies | 237600000X Audiologist-Hearing Aid Fitter (Licence: KY 240) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-07-08 |